Provider Demographics
NPI:1528457868
Name:REJUVA MEDICAL AND WELLNESS CENTER L.L.C
Entity type:Organization
Organization Name:REJUVA MEDICAL AND WELLNESS CENTER L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-236-7610
Mailing Address - Street 1:10653 WAYZATA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1543
Mailing Address - Country:US
Mailing Address - Phone:952-236-7610
Mailing Address - Fax:952-426-0674
Practice Address - Street 1:10653 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1543
Practice Address - Country:US
Practice Address - Phone:952-236-7610
Practice Address - Fax:952-426-0674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty